Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $87.10 / $371.54	Facility	26	$69.18	$87.10	$371.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $208.93 / $512.86	Professional		$95.50	$208.93	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $81.28 / $208.93	Professional	26	$36.31	$81.28	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $107.15 / $302.00	Professional	TC	$57.54	$107.15	$302.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $120.23 / $208.93	Professional		$75.86	$120.23	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $44.67 / $85.11	Professional	26	$30.90	$44.67	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $75.86 / $134.90	Professional	TC	$43.65	$75.86	$134.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $204.17 / $213.80	Professional		$190.55	$204.17	$213.80
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $75.86 / $81.28	Professional	26	$70.79	$75.86	$81.28
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $125.89 / $131.83	Professional	TC	$117.49	$125.89	$131.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $213.80 / $323.59	Professional		$85.11	$213.80	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $85.11 / $120.23	Professional	26	$32.36	$85.11	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $134.90 / $208.93	Professional	TC	$53.70	$134.90	$208.93
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $181.97 / $181.97	Facility	26	$95.50	$181.97	$181.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $204.17 / $331.13	Professional		$128.82	$204.17	$331.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $79.43 / $229.09	Professional	26	$50.12	$79.43	$229.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $123.03 / $446.68	Professional	TC	$74.13	$123.03	$446.68
Midlands Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $234.42 / $371.54	Professional		$208.93	$234.42	$371.54
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $89.13 / $134.90	Professional	26	$79.43	$89.13	$134.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $147.91 / $234.42	Professional	TC	$131.83	$147.91	$234.42
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $162.18 / $257.04	Professional		$131.83	$162.18	$257.04
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $70.79 / $97.72	Professional	26	$70.79	$70.79	$97.72
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $91.20 / $162.18	Professional	TC	$61.66	$91.20	$162.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $91.20 / $218.78	Professional		$42.66	$91.20	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $158.49 / $251.19	Professional		$102.33	$158.49	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $63.10 / $100.00	Professional	26	$47.86	$63.10	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $100.00 / $154.88	Professional	TC	$67.61	$100.00	$154.88